McKay Courtney, Hall A Brad, Cortes Jennifer
Questions or comments about this article may be directed to Courtney McKay, PharmD, at
J Neurosci Nurs. 2015 Dec;47(6):327-32. doi: 10.1097/JNN.0000000000000170.
Elevated blood pressure is common in patients with acute ischemic stroke. Thrombolytic therapy is contraindicated in patients with a systolic blood pressure greater than 185 mmHg or diastolic blood pressure greater than 110 mmHg. Elevated blood pressure can lead to a delay in thrombolytic therapy, which is associated with increased morbidity. There is currently insufficient evidence to support the use of a specific antihypertensive agent in this setting.
This study aimed to compare the effects of labetalol, nicardipine, or hydralazine on time to target blood pressure before alteplase administration in patients with acute ischemic stroke.
A retrospective chart review was conducted to identify patients who received labetalol, nicardipine, or hydralazine to treat elevated blood pressure (systolic blood pressure > 185 or diastolic blood pressure > 110) before intravenous alteplase therapy for ischemic stroke. Data collection included time to blood pressure control, door-to-needle time, total dose administered, and use of additional antihypertensive agent(s).
Most patients in this study received labetalol (25/29). Median time to blood pressure control was 10, 22, and 15 minutes in the labetalol, nicardipine, and hydralazine groups, respectively. Among patients who received labetalol, the average time to blood pressure control was 10 minutes longer in those who received 10 mg initially versus those who received 20 mg. Patients who required higher total doses of labetalol tended to achieve blood pressure control more slowly, had longer door-to-needle times, and required additional antihypertensive agents.
Adequate initial dosing of antihypertensive treatment has the potential to reduce time to blood pressure control and possibly time to alteplase therapy. The optimal antihypertensive regimen for controlling blood pressure before alteplase therapy remains unclear.
急性缺血性脑卒中患者中血压升高很常见。收缩压大于185 mmHg或舒张压大于110 mmHg的患者禁忌溶栓治疗。血压升高会导致溶栓治疗延迟，这与发病率增加有关。目前尚无足够证据支持在这种情况下使用特定的抗高血压药物。
本研究旨在比较拉贝洛尔、尼卡地平或肼屈嗪对急性缺血性脑卒中患者在给予阿替普酶之前达到目标血压所需时间的影响。
进行一项回顾性病历审查，以确定在缺血性脑卒中静脉注射阿替普酶治疗前接受拉贝洛尔、尼卡地平或肼屈嗪治疗血压升高（收缩压>185或舒张压>110）的患者。数据收集包括血压控制时间、门到针时间、给药总剂量以及是否使用额外的抗高血压药物。
本研究中的大多数患者接受了拉贝洛尔治疗（25/29）。拉贝洛尔组、尼卡地平组和肼屈嗪组血压控制的中位时间分别为10分钟、22分钟和15分钟。在接受拉贝洛尔治疗的患者中，初始接受10 mg的患者比接受20 mg的患者平均血压控制时间长10分钟。需要更高总剂量拉贝洛尔的患者往往血压控制更慢，门到针时间更长，并且需要额外的抗高血压药物。
抗高血压治疗的初始剂量充足有可能缩短血压控制时间，并可能缩短阿替普酶治疗时间。在阿替普酶治疗前控制血压的最佳抗高血压方案仍不清楚。
